Ayo Oshowo

Changing trends in the management of colorectal cancers and its impact on cancer waiting times.

Objective  The aim of this study was to compare the differences in the presentation, management and waiting times for new colorectal cancer (CRC) patients over 5 years in a single metropolitan cancer centre.

Telephonic management of rectal bleeding in young adults – a prospective randomized controlled trial

Objective  The majority of young adults referred with rectal bleeding to a colorectal specialist clinic have a very low risk of serious disease such as cancer, and a high chance of gaining symptom relief by simple dietary changes.

Perforated duodenal diverticulae: importance for the surgeon and gastroenterologist.

We present the case of a 78-year-old woman who was admitted for an elective left hemicolectomy for diverticular disease. Two days following the elective procedure, bilious fluid was noted in her pelvic drain. The patient returned to theatre, where a perforated duodenal diverticulum was excised and the defect primarily repaired. The patient then developed a low output enterocutaneous fistula which was treated conservatively with nasojejunal feeding and resolved spontaneously.

Perforated duodenal ulcer in the puerperium

Perforated duodenal ulcer is an uncommon complication 1 week following emergency caesarean section for severe preeclampsia and obstetrics cholestasis. This rare postoperative complication may easily be misdiagnosed or treated as paralytic ileus with dire consequences. To underline the rarity of this condition, Hooker reported only a single case of proven duodenal ulcer following the deaths of 1,564 puerperal women in New York City from 348,310 pregnancies [1]. The aetiology of peptic ulcer remained an enigma although it is widely accepted now that infection with Helicobacter pylori is the most important factor in the development of duodenal ulcer. H. pylori is a bacterium that has adapted to living on the surface of the stomach and intestine causing ulcers and inflammation. It is strongly associated with peptic ulcer and gastric cancer and may be the commonnest human bacterial infection, infecting 50% of people worldwide and 80% in developing countries [2]. Overcrowded conditions associated with poverty lead to increased transmission and higher prevalence rates [3]. We report the case of a 29-year-old Bangladeshi woman who had an emergency caesarean section at 35 weeks 4 days following a failed induction of labour for atypical obstetrics cholestasis and preeclampsia. She had an emergency laparotomy 10 days after the emergency caesarean section for perforated duodenal ulcer. This was repaired using Graham–Steele patch with a vicryl suture. She had a stormy postoperative period after the laparotomy and discharged home 7 weeks following the emergency caesarean section. On review at 3 months postdelivery, she had made a full recovery.